What goes around. . .

. . .comes around. Back in 2000, our fire chief was looking for a graphic scheme for his new Tahoe. It was our first white vehicle, so it was a clean slate. As a joke, one of the firefighters (me!) gave him a Matchbox toy Tahoe with Fire Chief lettering and great swooping red and black stripes.

He liked it so much it became the basis for the actual lettering scheme. For a long while the whole story was on the department website.
Later, and for other reasons, the rest of our fleet evolved from red to white with crisscrossed red and gold stripes. They look sharp, if I do say so myself. We now operate the only non-red apparatus in our county, and the white has become a major part of our identity and a source of institutional pride.
Today, while out shopping, I found these:

Now go check out our ladder. I’ll wait here.
Coincidence? Probably, but it sure is cool.

Self indulgence


In the description of this blog, I refer to myself as a ‘firefighter, paramedic, train buff, family man.’ Most of my inspired writing lately has been fire/EMS related.

A bit of self-indulgence, if you would: Beth began school today. Real, yellow-bus, lunch-in-a-big-room SCHOOL. I’m so proud.
Where did all the time go? It seems like not long ago I was a rookie Lt/EMT with a new wife. Now the marriage is in double-digits and the child is in school.
And I wouldn’t change a minute of it.

Standard disclaimers apply

As noted in the header above, details have been changed in my stories in the interest of patient confidentiality. One of those details is the identifier of the unit(s) involved.

However, recently one of my employers changed their numbering scheme. Overnight, some of my fictional ambulances and paramedic units became ‘real.’ (Ooh, a hint about who he works for. Go ahead, Google. While I don’t mention it I’m not trying to hide.)

So to clarify (or further obfuscate?), while some of the units involved in my posts may have real-world equivalents, the numbers are random and not related. I’m thinking of switching to Ambulance 9/Paramedic 9 for future posts. (A glimpse into his psyche? Why 9?) But then again, for reasons known only to me I can’t use Engine 9, and Happy already uses Engine 99.

I also like the number 68 in homage to a favorite shift of yore. Engine 68? Maybe.

I am, and remain Mack505. (Or am I?)

Oh.

She met us at the door, with a suitcase in each hand, what we call a Positive Samsonite Sign. Angry Partner had been muttering to himself since we were dispatched. She was easily as large as both of us combined.


“I don’t feel safe,” she whined in a voice more suitable to someone 1/3 her size. The staff member from the group home, visible over her left shoulder, simply shrugged and turned away. He and AP both new her well. I, as a rookie, hadn’t met her before.


Before we could ask any more questions, she pushed between us and began a leisurely stroll down the steps to the waiting ambulance, with a suitcase in each hand. As we stared, she walked directly to the back of our rig, opened the doors, placed her suitcases inside, then turned to us. “You’ll have to lift me. I have bad knees.”


I heard the door of the group home slam behind us.


“I don’t feel safe,” she moaned again in the ambulance.


They don’t teach much psych stuff in basic EMT classes. Perhaps it’s because they don’t think we’d believe it. Perhaps they don’t know what to say; I often don’t. Part of me wonders if they withhold it so that our senior partners can get a good laugh out of us rookies.


“Why, what’s wrong? Is someone hurting you at the group home?” I doubted it, but it’s not impossible.


“No, the voices keep telling me to hurt myself.”


OK, definitely not in the manual. A quick glance around the ambulance confirmed that there was nothing handy which she could use to hurt herself or me.


“Well, just ignore them. We’re taking you someplace safe.”

“The voices are telling me to throw myself out of the ambulance.”


I could see AP watching me in the mirror. Something told me he’d been here before.


“You can’t,” I answered. “The doors are locked.”


“Oh.”

“Gakkkk.”


I looked up to see my patient attempting to choke herself with her own hands.


My rookie brain sprang into action. Choking = no airway. No airway = dead patient. This is NOT GOO- wait a minute! You can’t choke yourself to death, it’s like a toddler holding his breath to get what he wants. The absolute worst case is that you will pass out, loosen your grip, and wake up again.


I felt the ambulance swerve slightly, and I looked up to see AP laughing at me in the mirror. He saw me jump, and had probably seen the entire train of thought pass across my face.


*sigh* “Knock it off. We both know that won’t work.” She did.

We arrived downtown at Local Psych Facility with 10 minutes left in our midnight shift. We assisted the patient out of the truck, and my partner took her suitcases. I sensed he wanted to get this call completed as soon as possible.


The patient began to shuffle across the parking lot with both of us in tow. Halfway to the entrance, she suddenly spun on her heel, shouting, “I’m going to throw myself in front of a car!” and began to run toward the street. I didn’t know she could move that fast!


I dropped my clipboard and began to sprint after her. My partner froze and dropped her luggage. Before I’d gone two steps, I heard him bellow. “YOU CAN’T!”


The patient and I both stopped in our tracks and turned to him. Angry Partner stood with his arms crossed and his feet spread in his best parental I’ve-had-enough-of-this stance. “IT’S MIDNIGHT! DO YOU SEE ANY F***ING CARS?”


Our patient looked around briefly at the empty city. “Oh,” she said, and resumed her shuffle towards the door.

The Handover


This month’s edition of the Handover EMS Blog Carnival is up at over at Medic999.

This month’s topic is ‘Your First Emergency.’ Thanks to a guest post, we here at NfMH have two posts included! (Thanks, Mark.)
Why not pop over to Medic999 and see what everyone else wrote about?
If you enjoy what you see here or elsewhere in the Handover, I encourage you to check out my Blogroll in the sidebar. I’ve been slowly adding lots of good stuff to it.

Some Random Observations

A Powerstroke Diesel makes a cool ‘loping’ sound when running on only 7 cylinders.

It’s possible to waterski behind a fishing boat in shallow tidal water.

Shaving cuts do not need to be treated at the ER.

People will ask anyway. And be serious about it.

It’s possible to be suicidal and afraid of dying from chest pain at the same time.

Time spent posting in the cab of the truck is inversely proportional to the amount of reading/listening/viewing material with which you are equipped. (Forgetting your cell phone charger guarantees spending the whole day in the truck.)

My wife has a psychic ability to call me while I’m busy with a patient. The sicker the patient, the more likely she will call. (You know I love you, hon.)

“It’s 9 o’clock. Do you know where your children are?”

The big Sikorsky emerges out of the setting sun with a roar. Every head outside the hospital swivels to follow its gravity-defying progress as it circles above the helipad. Paradoxically, the sound of the twin turboprop engines increases as it slowly approaches the ground and the single waiting ambulance.

The ‘bird’ touches its wheels lightly to the ground, then ponderously settles onto its shock absorbing landing gear. Gravity gradually takes over from aerodynamic lift, tethering it once again to the earth. The whine of the twin jet engines diminishes, but the rotors never stop turning.

After 30 seconds which seems like an eternity, the door opens and the flight crew jogs to the waiting ambulance, using a peculiar hunched gait. This is a big helicopter, and it’s not necessary to duck under the rotors. Human instinct, however, will not allow the head any closer to those lethally spinning blades than absolutely necessary.

The crew disappears into the back of the ambulance, and the scene becomes a still life in motion. The ambulance with its blinking red lights and the helicopter with its wildly spinning rotors sit frozen alone on the tarmac, with not a soul in sight.

Inside the ambulance is a parent’s worst nightmare. He needs angels; the best we have to offer is a helicopter.

Shortly the ‘bird’ will reverse the drama of its arrival. The paramedics will retreat to the safety of their ambulance as the flight crew locks their own doors. The turboprops will increase their ferocity from whine to roar, and the parking lot will be swept clean of any remaining sand, leaves, and debris. This time there will be no dramatic circling; as soon as the wheels are clear of the treetops, the pilot will tilt the nose and begin a full-throttle run across the setting sun, directly for Big City Trauma Center. Hopefully the angels can keep up.

Somewhere tonight, a parent’s worst fear will come true. Johnny won’t come home for dinner. His parents will call his cell phone but not get any answer. They will wait a while and probably gently curse him for being so irresponsible. Then the doubt will begin. A phone call to his best friend, to Grandma, to the school. No answers. The doubt will slowly turn to fear. Eventually there will be a 911 call to report him missing, followed by a police officer and perhaps a priest arriving on someone’s front doorstep. Hopefully it will not be too late.

I resolve to hug my wife and daughter when I get home in the morning.

Stop Assaulting Me!

Firstly, my apologies to those who come here looking for my regular wit and wisdom. Normal programming will resume after this brief interruption.

I have a message for Corporate America: LEAVE ME ALONE!

It all started with the gas pumps. I remember a time, not that long ago, when Muzak was confined to the big stores at the mall. Then the gas pumps began playing it. I was annoyed, but I put up with it. Then they switched from music to advertising.

More recently, the pumps we use at work started running video advertising. Now there are TVs on the ceiling at Wal-Mart, the mall, the train station, and the airport. This afternoon I rode a C&J bus which had four televisions within my field of view, all showing the same episode of Gomer Pyle, USMC. Arrrgh!

Advertisers know that the human eye is drawn to motion. This human MIND, however, has had enough. I have an iPhone, an iPod, and a laptop computer. I’ve owned every personal entertainment device since the original Walkman. If I want audiovisual entertainment, I will provide my own. More importantly, if I don’t I will TURN IT OFF.

So hear me, Corporate America: I will not shop at your establishment if you assault my senses with unwanted audible and visual stimuli. I’m even willing to pay slightly more money for gas which comes from a quiet pump, and I already shop online and pay shipping costs to avoid stores which overwhelm.

If you want my business, turn off the TV. Who’s with me?

We now return you to our regularly scheduled blogging.

Tyvek

Ambulance 79, take the response, along with Ladder 2 and Sin City Medics. Report of a man fallen from the roof.”

It looked like it would be one of those days. My partner and I were 10 minutes into our shift, and we hadn’t finished checking out the rig. Coffee (or in my case iced tea) was now at least 90 minutes in the future. We saddled up and headed out across town to be met by our first obstacle, a split street.

We could see the ladder company pulling up at the scene, but between us and them was the pedestrian mall of a high-school campus. As it was summer, the area was deserted; however, it has a small flight of stairs in the middle. I didn’t doubt A79’s ability to descend a flight of four steps, but the mechanic would have me drawn and quartered if he found out.

We hung a left, adding four blocks to the route, then pulled into the block immediately behind the arriving paramedics. One look at the house told us this one could be interesting. What had been a two-story house now ended at the top of the first floor. There was no roof to fall from. Workmen were framing a whole new second story. There was construction paraphernalia strewn about and a demolition dumpster in the driveway. There was no sign of the patient, but the firefighters were already inside.

The interesting scene continued inside the house. Directly above the entryway was a four foot square hole, with sky and bits of flapping plastic visible. The staircase began directly below the hole, heading up to the flat deck and space beyond. It had a heavy wooden railing, with a decorative newel cap the size of a large melon, which was broken off and lying on the floor.

The floor. Wow. The floor consisted of random planks and pieces of plywood nailed to the floor joists, covering most (but not all) of the first floor. At least I hope they were nailed in place.

One of the stations in our state EMT exam involves c-spine immobilization. A patient/volunteer sits in a folding chair and we must secure his spine, without moving him, using a short spine board or Kendrick Extrication Device (KED). The technique is supposed to be used to safely remove a spine injury patient from a crashed car or other tight space. We laugh that only in the exam will you ever immobilize a patient sitting in a folding chair in the middle of a room, with plenty of space to work on all sides.

Our patient sat on a folding chair in the middle of the of the room, with plenty of space to work on all sides.

He was holding his left side and screaming in pain whenever he moved or even breathed. In between screams he threatened the life of the Tyvek guy.

Remember the bits of plastic hanging over the front door? Our patient had arrived for work this morning with his Dunkin DonutsGreat One’ in hand, trooped up the stairs with his tools, turned the corner, and stepped right into the unmarked, plastic covered hole. Gravity did what it always does, returning him to the first floor in the most expedient manner. Along the way he struck his chest on the railing, breaking off the newel cap and flailing at least three ribs in the process.

Not only did this resemble the state exam, but the KED was the perfect tool for the job. It allowed us to immobilize both his spine and his flail chest at the same time. Then the fun began. Protocol requires us to secure the injured fall patient to a long spine board, but this patient wouldn’t tolerate the pain. When we tried to complete the immobilization he screamed, swore, and tried to come up swinging. I can’t say I blamed him.

In the end we secured him as well as possible in light of his pain and potential injuries. We used the KED, placed him on the stretcher partially laid back, secured his head and torso to an inverted short spine board, and let him bend his knees to relieve the pain. I confess I was happy the medics would be explaining this one to the trauma team and not me.

We all loaded up into the Sin City medic unit, and off we went to Big City Trauma Center. At 0730 on a Tuesday morning. What fun!

When we rolled into the trauma room with our patient trussed up like a Christmas goose, the doctor leading the team puffed up and raised one finger to begin shouting at us, “What the. . .”

The Sin City medic, one of the nicest guys I know, curtly shut him down. “Shut up! There’s a reason for all this!” He went on to explain the patient’s injuries and circumstances.

The bosses at the construction site were justifiably worried about OSHA investigating the incident. If I were them I’d be more worried about our patient’s reaction when he returned to work.

And by the way, Big City Trauma Center has great iced tea.

Cancel Truck 127

Captain Stanley is my hero. There, I’ve said it.

For those not of the generation to immediately recognize the name, Captain Henry ‘Hank’ Stanley was the fictional character in charge of Los Angeles County Fire Station 51 in the 1970’s TV series ‘Emergency!’ He guided Gage, DeSoto, Kelley, Lopez and Stoker through more than 100 hour-long episodes and brought everyone safely home in the end.

In the past I’ve joked about using ‘Cap’ as a role model. Everyone laughs. This week as I was watching an old episode in syndication, I began to quantify what I meant.

Consider the following:

  • Captain Stanley never gets unduly excited or yells on the radio. Never.
  • He always has a plan. And it always works.
  • He’s fair.
  • He’s a nice guy, but still the boss. Everyone respects him.
  • He keeps his crews well trained. Most incidents are handled with a simple order or two: “Chet, Marco; inch and a half in the front door.” Done.
  • He leaves his personal life at home.
  • When blown across the room by an exploding {whatever}, he picks himself up and goes right back to work.

You could do much worse in a fire officer. Of course it’s easier when someone else scripts it all for you.

I know he’s a fictional character, but I’d be honored to serve with such a man. As a Lieutenant, I strive to embody those qualities myself. Especially the one about not yelling on the radio.

“LA, Engine 51. Cancel Truck 127. Station 51 out 20 minutes.”